Double unilateral fenestration of the anterior cerebral artery in the pre-communicating segment: a report of a unique case (original) (raw)
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A1-A2 anterior cerebral artery fenestration. a case report of a rare anatomical variant
European Journal of Anatomy
Cerebral vascular anatomical variations are not uncommon in the human population. Their prevalence is not exactly known, as most of them are incidentally diagnosed on angiography or postmortem dissections. We present a rare fenestration of the A1 segment of the anterior cerebral artery presenting with a ruptured saccular aneurysm. A 42-year-old hypertensive patient presented unconscious following a ruptured saccular aneurysm. The computer tomography angiography showed a fenestration of the right A1 segment of the anterior cerebral artery (ACA). The medial segment of the A1 was communicating with the left ACA via the Anterior communicating artery, while the lateral segment was directly joining the A2 segment of the same side. Intraoperatively, the two segments were identified as separate vascular structures not sharing adventitia, and of equal caliber. The aneurysm arising from the bifurcation was clipped. The patient recovered with no neurological deficits. Many vascular anomalies l...
Two variations of the anterior communicating artery: a clinical reminder
2000
Of the 30 cadavers we examined two unusual variations of the anterior communicating artery (ACoA) were observed. In the first case ACoA was duplicated with a fenestrated anterior cerebral artery (ACA). In the second case, an oblique ACoA was present. Further, two branches of the oblique ACoA were joined the right ACA. The clinical significance of the cases has been
Fenestrations of the human posterior cerebral artery
Child's Nervous System, 2014
The posterior cerebral artery (PCA), as a paired terminal branch of the basilar artery, runs through four segments (P1 to P4) to the inferior and medial surfaces of the occipital and a part of the temporal lobes. There are many PCA variants in its course. The literature data indicated that a fenestration of the PCA was very rare and that its clinical significance is unknown. The purpose of this investigation was to present the frequency, location, and some morphological features of PCA fenestration in the prenatal and postnatal period. Using brain bases of 468 (200 fetal and 268 adult) cadavers, we applied macroscopic and microscopic investigation. We found four (0.85 %) cases of PCA fenestrations-two at the left and right P1 segment of fetuses, respectively, then one adult at the left P2 segment, as well as one adult at one right PCA of the two existing arteries. There were associated multiple vascular abnormalities in one adult case. We did not find any case of PCA aneurysm originating from fenestration, as well as from PCA without fenestration. The frequency, segment, and side location, as well as the size and shape of PCA fenestrations in specimens of our population did not significantly differ from the same in other populations. PCA fenestrations in our adult specimens were not the bases of aneurysms.
Surgical and Radiologic Anatomy, 2021
This case report illustrates a new variant in the anterior cerebral artery complex, identified during carotid angioplasty. A 50-year-old male patient diagnosed with left carotid stenosis was diagnosed and treated by a cerebral angiography. During the procedure, crossed circulation in the anterior cerebral artery was identified. The presence of this variation demanded to discard distal emboli or artery dissection. Angioplasty was performed and the patient followed up without neurological deficit. Among the most possible and prevalent variations in anterior circulation, none of them explain the phenomenon we observed. Therefore, a new variant is established. The knowledge about variants in cerebral circulation is important to rule out pathology. Cerebral diagnostic angiography has become more available and frequent because of the rising in endovascular tools to treat stroke patients. Considering this new variation and others is important to discard pathology.
Basilar artery fenestration in association with aneurysms of the posterior cerebral circulation
Neuroradiology, 1997
Basilar artery fenestration is reported in 0.6 % of angiograms and in about 5 % of some autopsy series . It can occur anywhere along the course of the basilar artery but it is most frequent in the proximal basilar trunk, close to the junction of the vertebral arteries . Fenestration has been shown to be associated with defects in the wall at its proximal and distal margins . It is thought that this defect and the change in flow characteristics which occurs at the site predispose to the formation of aneurysms. The first reported case of an angiographically demonstrated aneurysm at the site of a fenestration appears to that of Hemmati and Kim in 1979 [6]. There have since been several reports of aneurysms distal to or at the site of a fenestration . Aneurysms at the site of a fenestration are uncommon and Sanders et al. , in their series of 16 basilar artery fenestrations identified in a retrospective review of 5190 angiogram reports, found only one aneurysm at the fenestration site, a 7 % prevalence [13].
Angiographic and Embryologic Considerations in Five Cases of Middle Cerebral Artery Fenestration
2002
Summary: Five cases of unilateral middle cerebral artery fenestration were observed during the prospective evalua- tion of 1466 consecutive cerebral angiograms (0.43% of 1170 patients) between January 1999 and July 2001. In each case, an early branching temporopolar artery was seen to arise from the inferior limb of the fenestrated segment. This finding suggests that early branching tem- poropolar arteries
Transcallosal and Pericallosal Courses of the Anterior Cerebral Artery
Medicina
(1) Background: The anterior cerebral artery (ACA) has a precommunicating A1 segment, followed by a postcommunicating A2 segment. Anatomically, after it sends off from the callosomarginal artery (CMA), it continues as the pericallosal artery (PCalA). A detailed pattern of the anatomical variations of the PCalA are needed for practical reasons. (2) Methods: There were 45 retrospectively documented Computed Tomography Angiograms of 32 males and 13 females. (3) Results: In 90 sides, eleven different types of PCalA were documented: type 1: normal origin, above the genu of the corpus callosum (CC) (51.11%); type 2: low origin, below the rostrum of the CC (8.88%); type 3: late origin, above the body of the CC (3.33%); type 4, initial transcallosal course (3.33%); type 5, duplicated PCalA (1.11%); type 6, azygos PCalA (2.22%); type 7, absent PCalA (CMA type of ACA) (7.78%); type 8: CMA continued as PCalA (5.56%); type 9: PCalA continued as the cingular branch (1.11%); type 10: PCalA type of ACA, absent CMA (14.44%); type 11: triple PCalA, with an added median artery of the CC (1.11%). Different types of CMA were also documented: type 0, absent CMA (17.78%); type 1, CMA with frontoparietal distribution (45.56%); type 2, CMA with parietal distribution (22.22%); type 3, low origin of CMA, either from A1, or from A2 (8.88%); type 4, CMA continued as PCalA (5.56%). Ipsilateral combinations of PCalA and CMA types were classified as types A-P. In 33/45 cases (73.3%), the bilateral asymmetry of the combined anatomical patterns of PCalA and CMA was documented. Additional rare variations were found: (a) huge fenestration of A2; (b) bihemispheric ACAs (6/45 cases); (c) twisted arteries within the interhemispheric fissure. (4) Conclusions: The PCalA and CMA are anatomically diverse and unpredictable. Therefore, they should be documented on a case-by-case basis before surgical or endovascular approaches.
Acta Neurochirurgica, 2008
Double fenestration of the anterior communicating artery (ACoA) complex associated with an aneurysm is a very rare finding and is usually caused by ACoA duplication and the presence of a median artery of the corpus callosum (MACC). We present a patient in whom double fenestration was not associated with ACoA duplication or even with MACC, representing therefore, a previously unreported anatomic variation. A 43 year old woman experienced sudden headache and the CT scans showed subarachnoid haemorrhage (SAH). On admission, her clinical condition was consistent with Hunt and Hess grade II. Conventional digital subtraction angiography (DSA) was performed and revealed multiple intracranial aneurysms arising from both middle cerebral arteries (MCA) and from the ACoA. Three-dimensional rotational angiography (3D-RA) disclosed a double fenestration of the ACoA complex which was missed by DSA. The patient underwent a classic pterional approach in order to achieve occlusion of both left MCA and ACoA aneurysms by surgical clipping. The post-operative period was uneventful. A rare anatomical variation characterised by a double fenestration not associated with ACoA duplication or MACC is described. The DSA images missed the double fenestration which was disclosed by 3D-RA, indicating the importance of 3D-RA in the diagnosis and surgical planning of intracranial aneurysms.
Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences, 2013
Fenestration of the basilar artery (BA) is a rare variant of the intracranial artery, well demonstrated in autopsy and angiographic studies. Some angiographic series show a high incidence of associated aneurysms at the basilar fenestration site. The purpose of this study is to report the incidence of BA fenestration, its configurations, associated aneurysms, and arterial anomalies in a large series of intracranial MR angiograms (MRAs). A total of 16,416 MRAs were retrospectively reviewed to identify the location, size and associated intracranial arterial anomalies of BA fenestrations. All images were obtained with the time-of-flight (TOF) technique. Of the 16,416 MRAs, 215 fenestrations were found in 212 cases (1.29%). Most fenestrations were located in the proximal BA. The average length of the fenestration was 4.6 mm; the largest was 15.6 mm. No aneurysm was found at the site of the fenestration. Thirteen aneurysms were found in nine cases at locations other than the BA: seven in ...
Anatomical Variations RARE TRIPLE ANATOMICAL VARIATION OF THE CEREBRAL ARTERIAL CIRCLE
2017
We report the rare association of an aneurysm of a lateral right persistent trigeminal artery (Saltzman type II), bilateral aplasia of the pre-communicating segment of both posterior cerebral arteries and bilateral fetal posterior cerebral arteries, in a 64 years old woman who suffered from progressive diplopia and right abducens nerve palsy, most likely due to nerve compression in the latero-cellar space. Successful endovascular coils embolization of the aneurysm was performed, with no immediate complications. CT, MR and angiographic findings are presented. Although infrequent as single variations, the association of these three arterial variations has not been reported in literature to our knowledge, having special importance in the diagnostic workup and therapeutic procedures in a patient with an embolic stroke, as well as in the planification of intracranial endovascular diagnostic and therapeutic procedures.